Spontaneous ascitic fluid infection in liver cirrhosis: Bacteriological profile and response to antibiotic therapy

Ganesh Bhat, K. E. Vandana, Sumit Bhatia, Deepak Suvarna, Cannanore Ganesh Pai

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis. Methods: Records of 600 patients with suspected SAI over a 4-year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm3. Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 % of base line value) by 72 h of therapy. Results: Seventy patients (11.6 %) had SAI, including 40 (57.1 %) culture-negative neutrocytic ascites (CNNA), 25 (35.8 %) spontaneous bacterial peritonitis (SBP), and five (7 %) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 % (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 %, while it was 53.3 % for quinolones, 70 % for piperacillin-tazobactam, and 93.3 % for cefoperazone-sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 % vs. 40 %, p < 0.001) and for patients with response compared to no response to first antibiotic (11.3 % vs. 53.8 %, p < 0.001). Conclusion: The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone-sulbactam could be a better alternative choice.

Original languageEnglish
Pages (from-to)297-301
Number of pages5
JournalIndian Journal of Gastroenterology
Volume32
Issue number5
DOIs
Publication statusPublished - 01-09-2013

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Ascitic Fluid
Liver Cirrhosis
Anti-Bacterial Agents
Infection
Ceftriaxone
Peritonitis
Ascites
Cefoperazone
Sulbactam
Cephalosporins
Therapeutics
Mortality
Neutrophils
Klebsiella
Cefotaxime
Quinolones
Treatment Failure
Bacillus
Epidemiology
Fibrosis

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

@article{a52387299c1c4d4ca6e9082c5bf17cb8,
title = "Spontaneous ascitic fluid infection in liver cirrhosis: Bacteriological profile and response to antibiotic therapy",
abstract = "Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis. Methods: Records of 600 patients with suspected SAI over a 4-year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm3. Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 {\%} of base line value) by 72 h of therapy. Results: Seventy patients (11.6 {\%}) had SAI, including 40 (57.1 {\%}) culture-negative neutrocytic ascites (CNNA), 25 (35.8 {\%}) spontaneous bacterial peritonitis (SBP), and five (7 {\%}) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 {\%} (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 {\%}, while it was 53.3 {\%} for quinolones, 70 {\%} for piperacillin-tazobactam, and 93.3 {\%} for cefoperazone-sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 {\%} vs. 40 {\%}, p < 0.001) and for patients with response compared to no response to first antibiotic (11.3 {\%} vs. 53.8 {\%}, p < 0.001). Conclusion: The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone-sulbactam could be a better alternative choice.",
author = "Ganesh Bhat and Vandana, {K. E.} and Sumit Bhatia and Deepak Suvarna and Pai, {Cannanore Ganesh}",
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Spontaneous ascitic fluid infection in liver cirrhosis : Bacteriological profile and response to antibiotic therapy. / Bhat, Ganesh; Vandana, K. E.; Bhatia, Sumit; Suvarna, Deepak; Pai, Cannanore Ganesh.

In: Indian Journal of Gastroenterology, Vol. 32, No. 5, 01.09.2013, p. 297-301.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Spontaneous ascitic fluid infection in liver cirrhosis

T2 - Bacteriological profile and response to antibiotic therapy

AU - Bhat, Ganesh

AU - Vandana, K. E.

AU - Bhatia, Sumit

AU - Suvarna, Deepak

AU - Pai, Cannanore Ganesh

PY - 2013/9/1

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N2 - Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis. Methods: Records of 600 patients with suspected SAI over a 4-year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm3. Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 % of base line value) by 72 h of therapy. Results: Seventy patients (11.6 %) had SAI, including 40 (57.1 %) culture-negative neutrocytic ascites (CNNA), 25 (35.8 %) spontaneous bacterial peritonitis (SBP), and five (7 %) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 % (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 %, while it was 53.3 % for quinolones, 70 % for piperacillin-tazobactam, and 93.3 % for cefoperazone-sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 % vs. 40 %, p < 0.001) and for patients with response compared to no response to first antibiotic (11.3 % vs. 53.8 %, p < 0.001). Conclusion: The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone-sulbactam could be a better alternative choice.

AB - Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis. Methods: Records of 600 patients with suspected SAI over a 4-year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm3. Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 % of base line value) by 72 h of therapy. Results: Seventy patients (11.6 %) had SAI, including 40 (57.1 %) culture-negative neutrocytic ascites (CNNA), 25 (35.8 %) spontaneous bacterial peritonitis (SBP), and five (7 %) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 % (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 %, while it was 53.3 % for quinolones, 70 % for piperacillin-tazobactam, and 93.3 % for cefoperazone-sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 % vs. 40 %, p < 0.001) and for patients with response compared to no response to first antibiotic (11.3 % vs. 53.8 %, p < 0.001). Conclusion: The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone-sulbactam could be a better alternative choice.

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